Compassion is a verb.

Donna Sollenberger, EVP & CEO, UTMB Health SystemOne year during the holidays in Wisconsin, I realized I had forgotten to get a greeting card to give to my father-in-law on Christmas morning, which my family celebrates. So my son, Blake, and I went to the local drugstore to find one.

While we were in the greeting card aisle, I noticed another lady who was also looking for a card. She reached the cashier just before we did. Standing in line behind her, we overheard her conversation with the cashier.

“That’ll be $5.99,” he said.

“Oh, I think it is only $1.99,” she replied.

The cashier double-checked the price. “No, it’s $5.99,” he said.

“But it was on the $1.99 rack. It’s for my daughter,” she replied.

The cashier then said, “No ma’am, I’m sorry. It must have been misplaced on the rack. It doesn’t matter where it was, it’s $5.99.”

Clearly disappointed, the woman exited the line to replace the card on the rack. My heart truly went out to her. After I had completed my transaction, my son and I waited outside of the store. I just had this feeling that I needed to do something to help, because I could tell she couldn’t afford the card. When she came outside, we handed her a twenty dollar bill.

“Please, go buy the card you wanted for your daughter. Get her a small gift.”

I don’t know if I can really describe my emotions at that moment, as the lady’s eyes welled up with tears. I just knew I had to do something to help this person in need.

I remembered this experience because we are in the midst of the holiday season, but I wondered if there was something special we could all do for someone else—and not only during the holidays. Every day is a day for practicing kindness, compassion and generosity. We have opportunities daily to help our patients and visitors—and it doesn’t have to cost a cent.

Recently, Laura Amos, a patient care technician in the Galveston Recovery Room, stopped to help a patient who was walking with her IV pole in a main corridor of Jennie Sealy Hospital. The patient looked as if she was about to pass out. Laura noticed this immediately and asked the patient if she was okay. When the patient replied that she felt weak and dizzy, Laura stayed with the patient while another employee got a wheel chair. Then, Laura assisted the patient into the chair and helped take her to transportation, who escorted her to her room.

We can always offer something of ourselves to someone else at any time, whether it is our talent or a skill, a little moral support, or a word of kindness. After all, “Generosity does not come from wealth. Wealth comes from the flowers of kindness and love,” says physician and author, Dr. Debasish Mridha.

Laura not only demonstrated compassion for this person, but by being observant and proactively interacting with this patient, she also helped prevent a potential injury to the patient if she had fallen. This is a wonderful example of Best Care, and a wonderful example of how, by simply being aware of those around us in our hospitals and clinics, we have a real invitation to brighten someone’s day.

“The best part of life is not just surviving, but thriving with passion and compassion and humor and style and generosity and kindness.” ~ Maya Angelou

Your silence gives consent. (Plato)

Donna Sollenberger, EVP & CEO, UTMB Health SystemMy passion for history began in middle school. In fact, much of my elective reading has always been about important historical events or the lives of famous people. Most of all, I really enjoy reading about the lives of presidents. Given the fact that I grew up in Springfield, Illinois, it probably would not surprise you to find out that I love to read about Abraham Lincoln. As a child, I grew up visiting Lincoln’s home and tomb, the Old State Capitol where the Lincoln/Douglas debates were held, and New Salem where a young Abraham Lincoln studied law by candlelight. Perhaps it also is not surprising that I love to read about President John F. Kennedy. When President Kennedy was shot, I was in middle school. That day was a defining moment in my youth. Even now, I read as much as I can about these two presidents.

Traveling a couple of weeks ago, I had forgotten my book. (I have a Kindle, but I still love to turn pages!) In the airport, I saw a paperback book called “Killing Kennedy: The End of Camelot”, written by Bill O’Reilly. I decided I would buy it, and I read it on the plane. To me, the best part of the book was about John F. Kennedy’s time in the Oval Office. In particular, I was fascinated by the account of the Cuban Missile Crisis and the Bay of Pigs.

In April of 1961, President Kennedy had made the decision to authorize the invasion of Cuba. First, however, he wanted to hear from his top advisors to determine if this was the best course of action. At the time, his Secretary of State was Dean Rusk, an Oxford-educated Rhodes Scholar who had served as a chief of war plans during World War II. He was experienced in organizing covert missions similar to this.

Dean Rusk had not been President Kennedy’s first choice as Secretary of State, and Secretary Rusk knew that. Consequently, he was not confident of his relationship with the new President. In a time when the President truly needed his advice, Secretary Rusk felt he should remain silent, despite the fact that he had shared with others that this operation was misguided and that it had a “snowball’s chance in hell” of succeeding.

Secretary Rusk was not the President’s biggest problem. His largest problem was that not one of his advisors was willing to give him their advice, because it was contrary to what the President wanted at that time. As a result, Kennedy gave the go-ahead on April 14, 1961 to proceed with the invasion. Almost immediately, the invasion was a disaster. Fidel Castro, who had recently overthrown Cuba’s American-backed president, had learned about the attack in advance from informants; meanwhile, the operation of attack did not go as planned. As a result, the Bay of Pigs invasion failed, and after less than a day of fighting, 110 men on the American side were killed and nearly 1,200 were taken prisoner.

This story resonated with me because perhaps the outcome of all of this could have been avoided if the people surrounding the President had been willing to speak up. But when they did not, many people paid the price for that decision.

Sally Hogshead, an author and professional speaker, once stated, “You will not make a difference by being quiet. You will make a difference by being heard.”

As a leader, I want people to challenge my thinking. It may not change my decision, but good decisions are made when all perspectives are heard. This does not mean the leader will always change his or her mind, but it does mean that all voices have been heard and considered.

Best Care requires that we speak up when we see something that can or may result in patient harm, and it requires that the person receiving the message listen carefully to what is being said. At UTMB Health, we are dedicated to serving others and improving the patient and family experience. We achieve this through demonstrating respect for our patients, their loved ones and our colleagues. When we respectfully offer constructive feedback, we do so with the intent to offer information that calls attention to a problem or prevents a potential problem. The objective is to have a conversation that leads to the best solution or course of action. Whether you are the individual receiving the feedback or the person delivering the message, maintaining a spirit of mutual respect and learning is of paramount importance.

As the person speaking up, we need to remember the following:

  • Whenever possible, convey your positive intent by choosing a good time to talk, when the other person can listen and respond thoughtfully. In instances when you are caring for patients, you may have to speak up at that moment in order to avoid patient harm.
  • Let the person know that you respect his or her position/role, and that is why you are willing to share this feedback. It is always best to discuss concerns directly with the other individual—avoid communicating through a third party. Take care with your words—focus on the behavior or action that needs improvement, not on the person. It is helpful to link the behavior or action to patient safety or other important business needs.
  • Maintain an objective tone. Listen objectively, as well.
  • Try to keep your message brief and concise. When possible, consider picking out one or two significant consequences of the action and discussing them.
  • Be sure to include specific descriptions as part of the conversation. Facts generally point toward a solution.
  • Leave the responsibility for action with the other person. If there is still the possibility for patient harm and the appropriate action is not taken, escalate the concern immediately.
  • Always thank the other person for their time, and ask them to reflect on the message, if that is possible.

As the person receiving the message, we need to make sure that we:

  • Focus on the content of the message, not on the person.
  • Realize and be appreciative that someone is making sure every action taken is being done in the best interest of our patients.
  • Listen calmly and attentively. Try not to plan a response while the other person is speaking (we are not really listening when we are busy thinking of how we will respond).
  • Listen with an open mind and acknowledge the other person’s concerns.
  • Ask questions to confirm your understanding.
  • Try not to take offense—instead, welcome suggestions.
  • Maintain an awareness of your feelings, but also try to suspend judgment or reaction until you have had time to consider the suggestions that were offered. Truly consider what is being said.
  • Respond respectfully, and thank the other person for expressing their thoughts or concerns.

The story of Secretary Rusk and President Kennedy is a great reminder of why every member of the team must be willing to speak up and be heard. It is only when we do this that we will achieve Best Care!

“If we remain silent, we are guilty of complicity.” – Albert Einstein

One person can make a difference, and everyone should try.

Donna Sollenberger, EVP & CEO, UTMB Health SystemBefore I share the patient letter I recently received, I wanted to begin with a story. Written by Loren Eiseley, I thought it was a great example of how each of you, through your everyday service and care of our patients and their loved ones, make a big difference. Although you may not always immediately see or hear about how the work you did impacted someone else’s life, your efforts often carry a significance far greater to others than you may realize.

“Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out “Good morning! May I ask what it is that you are doing?”

The young man paused, looked up, and replied “Throwing starfish into the ocean.”

“I must ask, then, why are you throwing starfish into the ocean?” asked the somewhat startled wise man.

To this, the young man replied, “The sun is up and the tide is going out. If I don’t throw them in, they’ll die.”

Upon hearing this, the wise man commented, “But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can’t possibly make a difference!”

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, “It made a difference for that one.”

Each day, when you do something special for a single patient, for all of our patients as a whole, or even in support of a colleague, it matters. The letter that follows, which was written by a patient’s wife, provides a powerful example of how one of our employees, Care Manager Mary Jacinto, made this sort of tremendous difference in a family’s life.

As you know, a key strategy of UTMB’s Best Care initiative is to manage our patients’ care, not only while they are in the hospital, but also after they are discharged. For many patients, this is to help prevent readmission (for example, the care manager may follow up to make sure the patient is taking their prescribed medications); for others, the goal is to help patients transition to another level of care or to help them find the resources they need to continue their care plan once they’re home. This letter tells the story of how, through Mary’s actions, she helped save a patient’s life:

“We want you to know how Mary Jacinto helped save my husband’s life. Back in September 2015, Michael [patient’s name is used with permission] got sick and was admitted to UTMB Galveston. Michael had cirrhosis with ascites, an enlarged spleen, an aortic aneurysm, hepatitis C and chronic obstructive pulmonary disease (COPD). After Michael was discharged, this is where Mary came into our lives as Michael’s Care Management Nurse.

We didn’t have insurance and little money. Mary got Michael lined up with the Freeport Clinic, so he could get the medical attention he needed. He wasn’t getting better and needed further medical attention. Mary used her resources and got Michael set up as a casebook study at UTMB.

In May 2016, we found out Michael had liver cancer and without a transplant, he only had a year to live. We still did not have insurance. I had tried several times to get insurance and wasn’t successful. Mary took the time to sit with me, and we did a conference call with the Health Market Place. We got insurance, effective June 1, 2016.

Then, Mary got Michael set up with the Liver Transplant Clinic. On August 8, 2016, Michael got a liver transplant at UTMB Galveston. He is doing fine and is very thankful to be alive. Because of Mary’s persistence, perseverance and caring ways, Michael is alive today! She is a very special person! We call her our angel! We want Mary to get the recognition she deserves.”

This is just one example, but this sort of amazing care takes place every day at UTMB. I can go on and on with examples of how individuals and teams across UTMB contribute to Best Care. In fact, just the other day, after a power outage in League City, individuals from Clinical Equipment Services, Nursing Services and many other areas discovered and preempted a potential patient safety issue with back-up batteries and emergency power. They then immediately took action to resolve the problem in a single evening. Some of the individuals who helped weren’t even on schedule that night, or they came in early the next morning to ensure everything had been addressed. To me, this sort of teamwork is outstanding and it proves that often, it is not one person or one action that makes the difference; it is the collective efforts of many who are working together toward a common goal.

As we continue the Best Care initiative and receive feedback from groups across the organization, leadership has learned that many people still aren’t sure how they impact Best Care. Although Best Care is largely focused on some areas for improvement that are difficult to impact for those who do not deliver direct patient care, I want to emphasize that each of you plays a very important role to the overall Best Care initiative. When it comes to helping patients navigate the health care system, ensuring they have a positive experience, or making sure needed supplies are delivered and facilities are operational, through your collective service, you make an impact.

Never doubt that one person’s efforts can make a difference. It did for Michael and will for so many others.


November 11 is Veteran’s Day.

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Save

It is in the shelter of each other that the people live.

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere is a proverb that says, “It is in the shelter of each other that the people live.” Have you have been in a position at some point in your life when you had to rely on the generosity of others? I would guess that most of us have. I know it has been true for me.

When I was 15 years old, my father unexpectedly lost his job. With three children and a wife to support, he was devastated and very worried about our family’s future. Fortunately, two things happened which made it possible for our family to transition through this challenging time until he got a new job.

First, my parents decided that my mother should return to work. In the mid-1960’s, a mother working outside the home was not the social norm. Nevertheless, my mom had been an exceptional legal secretary before she decided to stay home to focus on raising me, and eventually, raising my brother and sister. Fortunately, she had stayed in touch with her former employer during this time. So when my dad lost his job, my mom made an appointment to meet with her former agency to see if they had any job openings. Fortunately, they were hiring, and they offered her a job on the spot.

I remember there were tears of relief when my mother came home to say she would start working the following Monday. Because I was the oldest, my mother sat down with me to ask for help. She would need someone to be home for my brother and sister when they returned from school, and she would need me to cook dinner. I was so relieved that she would be able to help my dad and our family that I quickly agreed to do as she asked, even though it meant I would be giving up some of my after-school activities. To me, it felt like a small price to pay for my family’s future.

The other source of help we received came from my grandparents. I am not sure if my parents ever realized that I had overheard them asking my grandfather for a loan until we could get back on our feet. Fortunately, this is something my grandfather was able to do, and he told my parents not to worry about paying him back until they felt they were in a position to do.

This period of my life taught me a lot. First, the example of my mother’s former employer hiring her back on the spot taught me that it is important to stay in touch with people with whom I have worked in the past, as well as the importance of doing the best job possible while in their employ. Whether this relationship results in receiving a good reference or in assistance getting another job when the time is right, former employers and supervisors can be invaluable in helping us find future opportunities, should we ever need their assistance.

Secondly, and most importantly, I learned about the generosity of others and how it can make a tremendous difference in another person’s life when they need help. Whether the difficulty is losing a job, coming down with a serious illness, or any number of unfortunate and unforeseen circumstances, anyone can experience a situation in which they may someday need to rely on the help of others. This is the lesson foremost on my mind this week as we approach the close of this year’s State Employee Charitable Campaign (SECC), which ends on November 14.

Because of my experience as a 15-year-old, I have always supported organizations I believe in, such as the more than 300 charities represented by SECC. I have found that there are few things in life as satisfying as giving generously to help others, even though we may never know who has benefited from our gift.

For those of you who have already given to SECC, thank you! To those of you who have yet to donate, I hope that you will do so today. No amount is too small, and it is so easy to give. You can write a check for a one-time donation, or you can make a one-time or monthly gift through a payroll deduction. I know that some of you may not be in a position to give, but for those who are, please donate today. And remember, no gift is too small—we are harnessing the power of collective giving. Together, UTMB’s contributions will go far!

giving-donnas

Happy National Radiologic Technology Week (Nov. 6 – 12). Thank you for everything you do to deliver excellent patient care and promote healthcare safety!

Success is the sum of small efforts…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe famous artist Michelangelo once received a visit from a friend as he worked diligently on a sculpture. After a brief chat, the friend left but returned later to find Michelangelo working on the same statue. Thinking the statue was nearly completed on his last visit and seeing no visible change, he exclaimed, “You haven’t been working all this time on that same statue, have you?”

“Indeed I have,” the sculptor replied. “I’ve been retouching the facial features, refining the leg muscles, polishing the torso; I’ve softened the presentation of some areas and enhanced the eye’s expression.”

“But all those things are insignificant,” responded the visitor. “They are mere trifles.”

“That may be,” replied Michelangelo, “but trifles make perfection, and perfection is no trifle.”

Even today, painter, sculptor, architect and poet Michelangelo is still widely regarded as the most famous artist of the Italian Renaissance. Among his works are the “David” and “Pieta” statues and the Sistine Chapel frescoes. His work demonstrated a blend of psychological insight, physical realism and intensity never before seen.

The moral of the story? People and organizations who pay attention to the “little things” produce excellence in larger matters. As American entrepreneur, businessman and founder of the Marriott Corporation J. Willard Marriot said, “It’s the little things that make the big things possible. Only close attention to the fine details of any operation makes the operation first class.”

UTMB’s Best Care initiative is composed of many “moving parts”. There are a number of focused efforts in each area in which we are working to make significant improvements: reducing our observed mortality rate, improving effectiveness (doing or using the right things to achieve the desired patient outcome and best experience of care) and increasing efficiency (doing or using the right things to achieve the desired patient outcome and best experience of care). There is a tremendous amount of work in progress, and I am truly excited about the collaboration and teamwork taking place to make Best Care a reality.

Many of you are a part of the teams conducting this focused work, but everyone in every role at UTMB Health contributes to making our organization the best place to receive care and to have an excellent patient experience. I know you are all dedicated to this endeavor and have a desire to stay informed of our progress and the projects underway. That’s why this week, I would like to give you an update on some of the work that is taking place, as well as the work that will be conducted in the time to come.

Reducing UTMB’s Mortality Rate

At UTMB, all patient deaths are reviewed within 48 hours of the event, as generated in the Epic electronic medical record (EMR). Each death is then classified based on how likely the patient’s death was to occur—some patient’s illnesses are severe and they were expected to pass away, while other patients who passed away were not expected to. This is why detailed and specific clinical documentation is important when it comes to predicting mortality, because it illustrates how sick our patients are and it helps identify any additional illnesses or complications that may make care delivery more complicated. To aid in this documentation effort, an enhancement known as a “smart phrase” will be made in the EMR is forthcoming.

Another way we have improved our mortality rate—and more importantly, improved end-of-life situations for patients and their families—is to consult with patients and their families when the patient is expected to pass about moving into hospice care. This helps give them a choice about how to spend their last days and honors the patients’ preferences. So far, we have been able to transition 14 patients into comfortable end-of-life care. These efforts will continue and remain ongoing in the future.

Diagnosing, Treating and Preventing Sepsis

Sepsis is a leading cause of mortality. It is a bloodstream infection that results in tissue damage and organ failure. Sometimes patients arrive in the hospital with sepsis; at other times, they can develop it after a surgery (if this occurs, it is considered a patient safety event).

Recent work to improve our performance in this measure has focused largely on placing a workflow in the electronic medical record (EMR) to help providers follow the evidence-based care recommended for testing and treatment of sepsis. A report has also been developed to help monitor all patients with sepsis on their problem list—this helps ensure that if sepsis is initially documented as “suspected” or “probable”, it is eventually also documented as “confirmed” or “ruled out” and the final diagnosis is clearly documented.

Clinical documentation guidelines for the diagnosis, documentation and coding of sepsis and septic shock have now been posted to the Best Care website, and clinical documentation specialists and inpatient coders continue working closely with physicians on this area for improvement.

Clinical Documentation Improvement

After physicians document the care they provide in the medical record, it is later translated into codes which are used not only to determine the cost of care and reimbursements, but to help illustrate how sick patients are and to track disease trends. The documentation/coding process is fairly technical and detailed, but one important factor is to identify not only the primary diagnosis, but also identify and document any complications or co-morbidities (aka, secondary, co-existing illnesses). It is also important to note whether or not the secondary illness was considered “major” (meaning it required more resources to treat and was at the highest level of severity) or “simple” (meaning the condition resulted in some increased resources, but at a much lower rate).

When ICD-10 was implemented in October 2015, it changed how some conditions and procedures were classified. That is one reason why specificity of clinical documentation was strongly emphasized. However, it was predicted that on a national level, some services that are considered “procedural-heavy”, like general surgery, general medicine and cardiac services would be more susceptible to the impact of this shift than other areas of care.

At UTMB, clinical documentation improvement is focused in all services, but project teams are also particularly focused on Cardiology. To help providers make the best possible diagnosis choices, Department Chair Dr. Ken Fujise has requested that a template be developed for use in the EMR, and this work is in progress.

Effectiveness and Efficiency

Building on work already accomplished, Orthopaedics continues work to reduce patient length of stay and preventable 30-day readmissions through revised order sets (order sets are standardized lists of orders for specific diagnoses that help physicians follow evidence-based guidelines for care), conducting risk assessment for patients (that is, understanding what might put a patient at risk for readmission), and improved patient education and physical therapy training. Sometimes, a patient may need advanced care after a surgery, such as a knee replacement, but their condition isn’t serious enough to actually be admitted. By placing them in observation instead, which is a less expensive care environment, a 30-day readmission can be avoided.

Other areas of focus that are helping to improve the data for our readmission rate overall is ensuring that elective surgeries are clearly distinguished from non-elective surgeries and that inpatient procedures are accurately coded as planned or unplanned.

Last but not least, throughout the inpatient arena, patient care teams continue conducting progression of care rounds and using the “8 Ps” (an assessment of preventable risk factors for readmission). Teams also continue conducting and documenting “Teach Back”, which helps ensure that patients understand their condition and how to care for themselves at home. Care managers remain focused on following up with patients after they are discharged to ensure they are following their plan of care. Particular attention is being given to caring for hospital-dependent patients.

“Success is the sum of small efforts – repeated day in and day out.”

As you can see, there is a lot of work going on! Although I mentioned a couple of weeks ago that we slipped in our rankings in the most recent Vizient Quality & Accountability Study, all of the amazing work I described above was not included in the data submitted for that study’s time period. Therefore, I am confident that if we continue these efforts and maintain a steadfast focus on Best Care, including maintaining our performance in patient-centeredness and equity of care, we will be successful in our endeavor to become a top 20 academic medical center in the next study.

Thank you all for your diligence and hard work! And remember, it’s the things we work hard for that have the greatest worth. We have a tremendous opportunity to prove that UTMB Health is the best place to receive patient care!

Quote attributed to Robert Collier

Lifting People Up

Donna Sollenberger, EVP & CEO, UTMB Health SystemEach day at UTMB Health, people’s lives are touched in positive ways by our employees. Last week, I heard a story I wanted to share with you about an employee who went the extra mile to lift a patient’s spirits.

Nurse Keith Sumrall was working on the Pediatric Unit in John Sealy Hospital. One of the patients for whom he was caring had just been through a tough surgery; he also had an intellectual disability which made him feel especially anxious about the entire experience. One evening, as Keith left the patient’s room, he asked if there was anything else he could do. Kyle* had his heart set on one thing: a Kit Kat bar.

There were no Kit Kat bars on the unit to take to the young patient. The next day, Keith decided to buy something sweet for his patient. However, he didn’t return to the room with just one candy bar—he arrived with 60 Kit Kat bars, which he poured onto the bed cover in front of Kyle. The expression on the young man’s face was priceless. The moment was captured by his father, who videotaped the encounter.

Who would have thought that Kit Kat bars could bring that much joy to a patient who had been through so much that week? Kyle was so appreciative, he decided to name his new teddy bear after Keith.

I received another story on Wednesday from Dr. Joan Richardson, Chair of Pediatrics. It was an article that appeared in the New York Times (click here to read the article) about the experience of a family at CHA Cambridge Hospital in Massachusetts. Although the story did not take place at UTMB, it very easily could have.

The article featured the letter from the patient’s husband, who wrote about the professionalism of the staff, their kindness and compassion, and their consideration for the patient’s dignity and the family’s comfort. The staff also made it possible for the husband to have one last tender experience with his wife. These are all the types of things I hear about almost daily from our patients and their loved ones here at UTMB.

These two stories are examples of people who took delivering Best Care to a whole new level. Best Care is more than medicine. It is showing compassion and kindness for people who truly need our care. We should always ask patients and their loved ones if there is anything else we can do for them, and if there is something we can do to help (even if it is not within our scope of responsibility) we should find a way—we can always lend an ear, and we can always treat our patients and their loved ones with the same care and respect with which we would want to be treated.

Best Care is about understanding our patients’ needs and then doing what we reasonably can to meet them. It’s about living our values. The employees in these stories did exactly that as they demonstrated what exceptional patient care is all about.

Thank you to all of you who work together to truly work wonders for our patients and deliver Best Care, every patient, every time!

“THERE IS NO EXERCISE BETTER FOR THE HEART THAN REACHING DOWN AND LIFTING PEOPLE UP.”
John Holmes

* The patient’s name and video above are shared with permission of the patient’s family.


SECC Don’t forget! The State Employee Charitable Campaign (SECC) is underway! SECC is a chance to give back to our communities and the important causes that are near and dear to us.

To all who have already committed to SECC, thank you!  To those who have not yet given, please give this every consideration. No amount is too small, and giving could not be easier. One-time contributions can be made via cash, check or online, or pledges can be made through payroll deduction (monthly or a single gift).

Please visit the SECC website at https://www.utmb.edu/secc  to begin the process of making your donation today. The deadline to contribute to the campaign is November 14, 2016.

Remember Why You Started

Donna Sollenberger, EVP & CEO, UTMB Health SystemHave you ever worked really hard to improve at something, only to find that after dedicating a lot of time and attention to it, you did not get better? Or worse yet, that you didn’t even do as well as when you started? Did you give up, or did you make adjustments and work even harder?

When I was in my early 20’s, I decided I would take up golfing. Many of my friends played, and I thought it would be a good skill to have, especially if I were going into business. Everyone in business plays golf, right?

The first thing I set out to do was purchase a set of golf clubs. I am left-handed, so borrowing clubs was out of the question, and no one I knew had left-handed clubs that I could borrow. I had even tried playing a round of golf using right-handed clubs, but wow, was that a mistake! I didn’t even get through three holes before I realized it simply wasn’t going to work.

So, I set out in search of some left-handed golf clubs. I had been saving up for a new car, but I decided since my car was running fine, I would use the money to buy my clubs instead. I would love to say that they helped my performance, but they did not.

Despite family members who tried to teach me and despite the lessons I paid for with more of my car savings, nothing helped. In my entire life, I have played nine holes of golf twice. I am sure it was entertaining to those accompanying me—I would miss the ball and hit the grass with the club, knocking up a chunk of earth, or I would swing repeatedly at the air while trying to tee off. Then, it would take me about 10 strokes just to get to the green. While I was a pretty good putter, it did not make up for the rest of my performance.

Ultimately, I decided that golf was not my game; so, I invested my time in playing other sports I was good at like volleyball, softball and bowling. (I ended up being pretty good at bowling!) However, I have often wondered how good I could have become at golfing if giving up hadn’t been an option. I guess I will never know…

This experience made me think about Best Care. Last week, we received our results from Vizient for the quality and safety data we submitted in parts of 2015 and 2016. While we are still generally in the top 20 for equity and patient-centeredness, and we are almost at the top 20 for patient-safety, we have fallen in our overall ranks for mortality, efficiency, and effectiveness. As a result, our overall score fell from being 58th to 76th out of a little more than 100 academic medical centers. While we are still in the three-star category, our results within that range slipped.

What happened? There are several things to point out:

  • The 12 months of data we submitted did not include most of the last four months of effort we have given to the Best Care initiative. This means that some of the great progress we have made so far was not captured in this set of data. This was particularly evident in the category of mortality; for example, we know we have made considerable progress by converting patients who were expected to pass away to hospice care at the right time.
  • As we had already anticipated, several items were also added to the survey this year which affected the scores. For example, length of stay (LOS) was previously calculated according to the date of inpatient admission and the date of discharge. Now, patients who are being observed but are later officially admitted are also included in this count, and the time they spent in observation is included in their length of stay, thus increasing UTMB’s overall length of stay performance.
  • We have identified issues that are creating the need to keep patients in observation, such as limited availability of some weekend services in the hospital (other than what is needed for emergency services). The Health System has started working with affected departments to help improve patient access for those services on a routine basis.
  • It should be noted that several services have improved their performance by reducing their length of stay, as well as the direct cost of care for the patient. So, there was some positive news in the latest results.

We will be looking very closely at the data this week and developing the additional action plans we need to meet our Best Care goals, but we need everyone to stay focused on what we need to do in our individual roles—and most importantly as part of our teams—in order to be successful.

They say, “When you think about quitting, remember why you started.” Unlike my decision to give up on golfing, quitting Best Care is not an option for us. We have to double down on our efforts—we owe it to our patients and their families and we owe it to ourselves to show the world that the care and service delivered at UTMB is the very best. When the Vizient Quality & Accountability Study comes out next fall, and we are in the top 20, our efforts to “Be the Best” will not end. Maintaining that position will be as challenging as achieving it. It is hard work to always deliver Best Care, but it is also highly rewarding.

I am convinced with the many good people we have working together on Best Care, that we will achieve our goals. Thank you for all of your contributions to and work on behalf of our patients to assure that they receive Best Care – every patient, every time.

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Unless we think together, we will fail to get the best out of one another!

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere once was an executive named Joe, who worked for a medical device company. Joe was very worried about the device that he was working on. He thought that it was too complicated, and he thought that its complexity created margins of error that could really hurt patients.

He wanted to find a way to help, but when he looked around his organization, nobody else seemed to be at all worried. So, he didn’t really want to say anything. After all, maybe they knew something he didn’t. Maybe he’d look stupid. But he kept worrying about it, and he worried about it so much that he got to the point where he thought the only thing he could do was leave a job he loved.

In the end, however, Joe did find a way to raise his concerns. And what happened then is what almost always happens in this situation—it turned out everybody had exactly the same questions and doubts! So now Joe had allies, and everyone on his team was thinking about how to solve the problem together. And yes, there was debate and argument, but that allowed everyone around the table to be creative, to solve the problem, and to change the device.

By speaking up, Joe wasn’t undermining anyone’s work. In fact, he was improving the overall quality of the team’s work and protecting others from harm. Joe had always been passionately devoted to his organization and the higher purposes that the organization served, but he had always feared the conflict that would result from speaking up. When he did finally speak up, he discovered that he had not only contributed much more to the team than he had ever imagined, but his colleagues did not think negatively of him—they thought of him as a leader.

The story above was borrowed from a presentation by Margaret Heffernan, a writer and keynote speaker who frequently presents on how conflict avoidance and selective blindness can lead organizations astray. Fear of conflict is the very thing that leads to communication breakdowns and broken processes, which in turn, result in preventable errors.

We know from the premise of our Culture of Trust that significant safety failures are almost never caused by isolated errors committed by individuals. Rather, they result from multiple, smaller errors in environments with serious underlying system flaws. This is why regular feedback and communication is important.

A couple weeks ago, I shared a story about my own experiences with constructive feedback, and how at times, I have also found it uncomfortable to give and to receive. However, I realize the importance of constructive conversations, and even though they may involve a difference of opinion, they are a very necessary part of conducting safe, effective and successful work for several good reasons:

  1. We don’t always have an internal cue that lets us know that we’re wrong about something until it’s too late.
  2. Without a shared understanding of people’s points of view when it comes to concerns, people might blame problems on other people, and not where it actually should be, like broken or inefficient processes.
  3. Continual two-way feedback allows people to focus on one or two areas for improvement, rather than having to address a much larger problem that has already caused harm or will require significant intervention and time to resolve.

If we truly care about providing the safest care for our patients, we will be committed to speaking up. Continual quality and safety improvement is the right thing to do. As we observed in Joe’s case, speaking up helped the team and the individual to achieve success. That is why we have to be willing to listen to and consider what others are saying to us. Individually, we must keep an open mind and be willing to work through problems strategically. As a team, we know this is important because it will ultimately help us succeed. Unless we think together, we will fail to get the best out of one another!

Whether we have a gut feeling about the condition or functionality of a device, or we feel concerned that a care process may be unsafe, we need to act with safety in mind and speak up. In health care, we are accountable for our own actions and for those of our team. As we go about our important work, let’s be conscious of any system design that may potentially cause harm if we do not identify the flaws and fix them before a patient is affected. Instead of being afraid of conflict, we have to address the issues head-on.

My job is to make sure that you have what you need to be able to take care of our patients. If you don’t, my hope is that you will make your manager aware, and if you are the manager and you cannot get what you need to ensure your team can provide the right care at the right time in the right way for your patients, you will continue to escalate the matter, without fear of consequence, until you get a resolution. This does not mean that the decision will always be exactly what you want or asked for, but you should receive an answer and a resolution that leaves you with a sense of closure.

Remember: “You can blame people who knock things over in the dark or you can begin to light candles. You’re only at fault if you know about the problem and choose to do nothing.” – Paul Hawken

If you aren’t in over your head, how do you know how tall you are?

Donna Sollenberger, EVP & CEO, UTMB Health SystemEarly in my career, I worked as the administrator in the department of surgery of a small medical school in Central Illinois. It was a wonderful setting to begin my administrative career, because I had the chance to experience many opportunities I wouldn’t have otherwise been given at a much larger medical school.

One of those experiences surfaced around the advent of the personal computer. Our chair of surgery decided he wanted to replace the institutional mainframe with a local area network (LAN) for the whole department. And that would not have been a problem, except for the fact that he wanted the department to manage it, not the chief information officer (CIO) for the school.

The chair assigned one of our researchers, an individual with a great aptitude for computers, to negotiate this change with the CIO. After three months of meetings, however, neither side wanted to budge on who “owned” the network.

At that point, the chair told me that he wanted me to “broker” this deal and get the CIO to concede the management of the network to the department. Because he was my boss, I agreed, but I have to tell you I was reluctant—I knew very little about computers and even less about personal computers and local area networks! The only thing that boosted my confidence was that I generally could get people to come together and reach an agreement, even when they had not been able to before.

At the first meeting, I let the researcher and the CIO do most of the talking. I asked them to tell me, from their perspective, how each envisioned the system would be configured and implemented, and what each thought the barriers were to reaching an agreement. As the talking continued, I remember thinking that the meeting might as well have been in a foreign language, because I was not fluent in half the terminology they used once they got into specifics. I left the meeting wondering what I could ever do to move this discussion along, and I was a little concerned about whether I could actually get these two gentlemen to agree.

Rather than accept defeat, I began reading everything I could about LANs and their configuration, the future of the mainframe in a world evolving to use personal computers, and how others had managed similar implementations. I knew that in order to accomplish the job I’d been assigned, I had to educate myself. Although I was daunted by the learning curve, I was also energized by the possibility of learning about something which was definitely going to change how we worked.

When the project ended two months later, I had successfully brought the researcher and CIO to an agreement. Today, the details of that agreement have faded from memory, but what I do remember is that the CIO agreed to support us in putting the LAN in the department as a pilot for the rest of the medical school, the researcher could define the configuration, and the system would be maintained by the CIO and his team. Meanwhile, I had become the “go to” person in administration for other departments as they each began to implement their own networks.

Albert Einstein once said, “The only source of knowledge is experience.” I had used an opportunity to increase my value to the organization and better prepare myself for a changing future. And, I had helped the departments involved maintain a positive relationship.

I believe that with the right attitude, we can completely reframe the way we experience challenges—we can take advantage of challenging situations to unlock our untapped strengths and abilities. Each time we do this, it will increase our confidence until we begin to see most challenges as opportunities to harness our personal power to an even greater degree.

I am reminded about this story each time we take on something new. We have a choice: we can either resist change or even try to keep the inevitable from happening; or, we can personally take the necessary steps and contribute to making the change a success. If you refuse to let challenges intimidate you or slow you down, you just might inspire and motivate others to do the same when they face obstacles of their own. Anytime you experience personal growth, you help the people around you in some way!

ts eliot

Success is the natural consequence of consistently applying the basic fundamentals.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI admit it! I love college basketball. Not just any college team, however. I am an avid Kansas University basketball fan (the “why” is a story for another time). We are now about three weeks away from the beginning of March Madness, and other than work, it is hard for me to focus on anything other than watching the games in the evening and on weekends.

My love of the sport began in high school. My senior year, our high school team came in third in the state tournament. I remember walking into the Assembly Hall at the University of Illinois and being overwhelmed by the sheer size of the field house. Today, that experience reminds me of the movie, “Hoosiers”, when Gene Hackman’s team gets to the state tournament. As the team walks into the field house for the first time, Hackman’s character is aware that the team feels overwhelmed by the size of the venue. He asks the players to begin measuring the court. Little by little, they become aware that nothing about the size of the court has changed. What has changed is simply the size of the field house where they are playing.

In many respects, playing in a national or state tournament is a lot like working in health care. The magnitude of what we have to do seems greater than ever before, but the fundamentals of what we do, much like the basketball court, has not changed. Our job is to take the very best care of patients and families that we can. In our tournament, we strive to BE THE BEST!

When I lived in Madison, Wisconsin, the basketball players had to run the hills on the outskirts of the city. Day after day, up and down the hills the players ran. It was not exciting; in fact, it was probably very boring, but year after year, the Wisconsin Badger’s conditioning pays off. Through hard training and practice, under the leadership of Bo Ryan, Wisconsin has become a regular contender in the Road to the Final Four. Last year, they made it to the Final Four.

When I was at the University of Kansas, Coach Ted Owens made his players shoot free throw after free throw, and often it was their predictable free throw shooting that made the difference in their wins. Again, this repetition and daily practice wasn’t glamorous, nor as entertaining as racing down the court, crossover dribbling behind one’s back and dunking the ball, but it was the difference that made the win for the Kansas Jayhawks.

In health care, we condition ourselves through practice—doing the same thing, the same way, every time. That consistency is a must in health care. It is when we deviate from the plan, when we decide that we can do something better than the way we were trained, that we end up not doing well. As we practice doing something over and over, we get better at it, and therefore provide safer care to our patients. Whether it is calling time outs, or reviewing and signing patient histories and physicals, whether it’s gelling our hands before and after entering a patient room, or developing our budgets, training and consistency pays off for our patients and provides the underpinning to BE THE BEST.

As you think about your work this week, what do you need to practice or have your team practice to assure our progress toward the goal – TO BE THE BEST?

“I stick with the fundamentals. The basics.”

—Bo Ryan